Sepsis is an often fatal clinical syndrome that develops after infection or injury. Sepsis is the most frequent cause of mortality in hospitalized patients. Experimental models of gram negative sepsis based on administration of bacterial endotoxin (lipopolysaccharide, LPS) have led to an improved understanding of the pathogenic mechanisms of lethal sepsis and conditions related to sepsis by virtue of the activation of a common underlying inflammatory cytokine cascade. This cascade of host-response mediators includes TNF, IL-1, PAF and other macrophage-derived factors that have been widely studied as acute, early mediators of eventual lethality in severe endotoxemia (Zhang and Tracey, In The Cytokine Handbook, 3rd ed. Ed. Thompson (Academic Press Limited, USA). 515 547, 1998).
Unfortunately therapeutic approaches based on inhibiting these individual “early” mediators of endotoxemia have met with only limited success in large prospective clinical trials against sepsis in human patients. It is possible to infer from these disappointing results that later-appealing factors in the host response might critically determine pathogenesis and/or lethality in sepsis and related disorders. Accordingly, there is a need to discover such putative “late” mediators necessary and/or sufficient for part or all of the extensive multisystem pathogenesis, or for the lethality, of severe endotoxemia, particularly as endotoxemia is representative of clinical sepsis and related clinical disorders.
HMG1 is a 30 kDa chromosomal nucleoprotein belonging to the burgeoning high mobility group (HMG) of non-histone chromatin-associated proteins. As a group, the HMG proteins recognize unique DNA structures and have been implicated in diverse cellular functions, including determination of nucleosome structure and stability, as well as in transcription and/or replication. The HMG proteins were first characterized by Johns and Goodwin as chromatin components with a high electrophoretic mobility in polyacrylamide gels (see in The HMG Chromosomal Proteins, E. W. Johns, Academic Press, London, 1982). Higher eukaryotes exhibit three families of HMG proteins: the HMG-1/-2 family, the HMG-14/-17 family and the HMG-I/-Y family. Although the families are distinguishable by size and DNA-binding properties, they are similar in their physical properties. HMG proteins are highly conserved across species, ubiquitously distributed and highly abundant, and are extractable from chromatin in 0.35 M NaCl and are soluble in 5% perchloric or trichloroacetic acid. Generally, HMG proteins are thought to bend DNA and facilitate binding of various transcription factors to their cognate sequences, including for instance, progesterone receptor estrogen receptor, HOX proteins, and Oct1, Oct2 and Oct6. Recently, it has become apparent that a large, highly diverse group of proteins including several transcription factors and other DNA-interacting proteins, contain one or more regions similar to HMG1, and this feature has come to be known as the HMG1 box or HMG1 domain. cDNAs coding for HMG1 have been cloned from human, rat, trout, hamster, pig and calf cells, and HMG1 is believed to be abundant in all vertebrate cell nuclei. The protein is highly conserved with interspecies sequence identities in the 80% range. In chromatin, HMG1 binds to linker DNA between nucleosomes and to a variety of non-β-DNA structures such as palindromes, cruciforms and stem-loop structures, as well as cisplatin-modified DNA. DNA binding by HMG1 is generally believed to be sequence insensitive. HMG1 is most frequently prepared from washed nuclei or chromatin, but the protein has also been detected in the cytoplasm. (Reviewed in Landsman and Bustin, BioEssays 15:539 546, 1993; Baxevanis and Landsman, Nucleic Acids Research 23:514 523, 1995). To date, no link has been established between the HMG proteins and any clinical condition or disease.
HMG1 has been alternatively identified as a heparin-binding protein abundantly expressed in developing brain and dubbed “amphoterin” for its highly dipolar sequence, comprising two internal repeats of a positively charged domain of about 80 amino acids (the HMG1 box) and an acidic C-terminal domain containing a stretch of approximately 30 continuous glutamic or aspartic acid residues. Amphoterin/HMG1 has been localized to the outer surface of the plasma membranes of epithelial, and especially neuronal cells, where it has been specifically localized to the filipodia of neural cells. Inhibition studies have suggested that amphoterin/HMG1 is required for process (neurite) extension and amphoterin/HMG1 also may be involved in neuron-glia interactions (Merenmies et al., J. Biol. Chem. 266:16722 16729, 1991; Merenmies et al., J. Biol. Chem. 266:16722 16729, 1991; Milev et al., J. Biol. Chem. 273:6998 7005, 1998; and Salmivirta et al., Exp. Cell Res. 200:444-451, 1992). Amphoterin/HMG1 can be released from murine erythroleukemia cells after stimulation with the chemical inducer, hexamethylenebisacetamide (Melloni et al., Biochem. Biophys. Res. Commun. 210:82 89, 1995). Previous study suggested that the gene product of the HMG1 gene functions as a differentiation enhancing factor by stimulating α-PKC (Melloni et al., Biochem. Biophys. Res. Commun. 210:82 89, 1995; and Melloni et al., FEBS Lett. 368:466 470, 1995).
The HMG1 gene product has been shown to interact with plasminogen and tissue-type plasminogen activator (t-PA) and effectively enhance plasmin generation at the cell surface, a system that is known to play a role in extracellular proteolysis during cell invasion and tissue remodeling. Amphoterin/HMG1 has also been shown to interact with the receptor of advanced glycosylation end products (RAGE) (Mohan et al., Biochem. Biophys. Res. Commun. 182:689 696, 1992; Yamawaki et al., J. Neurosci. Res. 44:586 593, 1996; Salmivirta et al., Exp. Cell Res. 200:444 451, 1992; and Vassalli et al., J. Clin. Invest. 88:1067 1072, 1991), (Redlitz and Plow, Baillieres Clin. Haematol. 8:313 327, 1995; and Parkkinen et al., J. Biol. Chem. 266:16730 16735, 1991).
There is a longstanding need in the art to discover improved agents that can prevent the cytokine-mediated inflammatory cascade and have therapeutic activity in a large variety of cytokine-mediated inflammatory diseases. The present invention was made during the course of investigative research to identify agents that mediate toxicity, pathogenesis and/or lethality in sepsis and other disorders related by a common activation of the inflammatory cytokine cascade.
Diseases and conditions mediated by the inflammatory cytokine cascade are numerous. Such conditions include the following grouped in disease categories: Systemic Inflammatory Response Syndrome, which includes:
Sepsis syndrome
Gram positive sepsis
Gram negative sepsis
Culture negative sepsis
Fungal sepsis
Neutropenic fever
Urosepsis
Meningococcemia Trauma hemorrhage
Hums
Ionizing radiation exposure
Acute pancreatitis
Adult respiratory distress syndrome (ARDS)
Reperfusion Injury, which includes
Post-pump syndrome
Ischemia-reperfusion injury
Cardiovascular Disease, which includes
Cardiac stun syndrome
Myocardial infarction
Congestive heart failure
Infectious Disease, which includes
HIV infection/HIV neuropathy
Meningitis
Hepatitis
Septic arthritis
Peritonitis
Pneumonia Epiglottitis
E. coli 0157:H7
Hemolytic uremic syndrome c/thrombolytic thrombocytopenic purpura
Malaria
Dengue hemorrhagic fever
Leishmaniasis
Leprosy
Toxic shock syndrome
Streptococcal myositis
Gas gangrene
Mycobacterium tuberculosis 
Mycobacterium avum intracellulare
Pneumocystis carim pneumonia
Pelvic inflammatory disease
Orchitis/epidydimitis
Legionella 
Lyme disease
Influenza A
Epstein-Barr virus
Viral associated hemiaphagocytic syndrome
Viral encephalitis/aseptic meningitis
Obstetrics/Gynecology, including:
Premature labor
Miscarriage
Infertility
Inflammatory Disease/Autoimmunity, which includes:
Rheumatoid arthritis/seronegative arthropathies
Osteoarthritis
Inflammatory bowel disease
Systemic lupus erythematosis
Iridoeyelitis/uveitistoptic neuritis
Idiopathic pulmonary fibrosis
Systemic vasculitis/Wegener's gramilomatosis
Sarcoidosis
Orchitis/vasectomy reversal procedures
Allergic/Atopic Diseases, which includes:
Asthma
Allergic rhinitis
Eczema
Allergic contact dermatitis
Allergic conjunctivitis
Hypersensitivity pneumonitis
Malignancy, which includes:
ALL
AML
CML
CLL
Hodgkin's disease, non-Hodgkin's lymphoma
Kaposi's sarcoma
Colorectal carcinoma
Nasopharyngeal carcinoma.
Malignant histiocytosis
Paraneoplastic syndrome/hypercalcemia of malignancy
Transplants, including:
Organ transplant rejection
Graft-versus-host disease
Cachexia
Congenital, which includes:
Cystic fibrosis
Familial hematophagocytic lymphohistiocytosis
Sickle cell anemia
Dermatologic, which includes:
Psoriasis
Alopecia
Neurologic, which includes:
Multiple sclerosis
Migraine headache
Renal, which includes:
Nephrotic syndrome
Hemodialysis
Uremia
Toxicity, which includes:
OKT3 therapy
Anti-CD3 therapy
Cytokine therapy
Chemotherapy
Radiation therapy
Chronic salicylate intoxication
Metabolic/Idiopathic, which includes:
Wilson's disease
Hemachromatosis
Alpha-1 antitrypsin deficiency
Diabetes
Hashimoto's thyroiditis
Osteoporosis
Hypothalamic-pituitary-adrenal axis evaluation
Primary biliary cirrhosis